Abstract
Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.
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References
Barkham, M., Connell, J., Stiles, W., Miles, N., Margison, F., Evans, C., et al. (2006). Dose–effect relations and responsive regulation of treatment duration: The good enough level. Journal of Consulting and Clinical Psychology, 74(1), 160–167.
Barlow, D. H. (2010). Negative effects from psychological treatments: A perspective. The American Psychologist, 65, 13–20.
Bergin, A. E. (1963). The effects of psychotherapy: Negative results revisited. Journal of Counseling Psychology, 10, 244–250.
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., et al. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield′s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). New York: Wiley.
Binder, P. E., Holgersen, H., & Nielsen, G. H. (2010). What is a “good outcome” in psychotherapy? A qualitative exploration of former patient’s point of view. Psychotherapy Research, 20(3), 285–294.
Birnbaum, M. H. (2004). Human research and data collection via the internet. Annual Review of Psychology, 55, 803–832.
Busch, I., & Lemme, R. (1992). Schulenspezifische Unterschiede hinsichtlich der Einstellung der Therapeuten zur Wirkung von Psychotherapie. Berlin: TU Berlin.
Carey, T. A. (2010). Will you follow while they lead? Introducing a patient-led approach to low intensity CBT interventions. In J. Bennett-Levy (Ed.), Oxford guide to low intensity CBT interventions (pp. 331–338). Oxford: Oxford University Press.
Carey, T. A., & Spratt, M. B. (2009). When is enough enough? Structuring the organisation of treatment to maximise patient choice and control. The Cognitive Behaviour Therapist, 2, 211–226.
Connolly, M. B., & Strupp, H. H. (1996). Cluster analysis of patient reported psychotherapy outcome. Psychological Research, 6, 30–42.
BGB1.I. Datenschutzgesetz 2000. (Vol. 165/1999). http://www.ris.bka.gv.at/Dokumente/BgblPdf/1999_165_1/1999_165_1.pdf. Accessed 21 May 2012.
Elliott, R. (1991). University of Toledo: Investigating significant therapy events. In L. E. Beutler & M. Crago (Eds.), Psychotherapy research—an international review of programmatic studies (pp. 317–321). Washington, DC: American Psychological Association.
Fäh, M. (2002). Wenn Analyse krank macht. Methodenspezifische Nebenwirkungen psychoanalytischer Therapien. In M. Maertens & H. G. Petzold (Eds.), Therapieschäden: Risiken und Nebenwirkungen von Psychotherapie. Mainz: Matthias-Grünewald-Verlag.
Frank, M., & Fiegenbaum, W. (1994). Therapieerfolgsmessung in der psychotherapeutischen Praxis. Zeitschrift für Klinische Psychologie, 23(4), 268–275.
Frohburg, I. (2001). Untersuchungen zum Schadensverständnis von Gesprächspsychotherapeut(inn)en. In M. Märtens & H. G. Petzold (Eds.), Therapieschäden: Risiken und Nebenwirkungen von Psychotherapie. Mainz: Matthias-Grünewald Verlag.
Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web based studies? A comparative analysis of six preconceptions about Internet questionnaires. American Psychologist, 59(2), 93–104.
Grawe, K. (2005). (Wie) kann psychotherapie durch empirische Validierung wirksamer werden? Psychotherapeutenjournal, 1, 4–11.
Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., et al. (2005). A lab test and algorithms for identifying clients at risk for treatment failure. Journal of Clinical Psychology, 61, 155–163.
Hatfield, D. S., McCullough, L., Plucinski, A., & Krieger, K. (2010). Do we know when our clients get worse? An investigation of therapist’s ability to detect negative client change. Clinical Psychology and Psychotherapy, 17, 25–32.
Heins, M. J., Knoop, H., & Bleijenberg, G. (2011). Reply to “harms of cognitive behavior therapy designed to increase activity levels in chronic fatigue syndrome”. Psychotherapy and Psychosomatics, 80, 112.
Heins, M. J., Knoop, H., Prins, J. B., Stulemeijer, M., van der Meer, J. W. M., & Bleijenberg, G. (2010). Possible detrimental effects of cognitive behaviour therapy for chronic fatigue syndrome. Psychotherapy and Psychosomatics, 79, 249–256. doi:10.1159/000315130.
Hermer, M., & Röhrle, B. (2008). Therapeutische Beziehungen: Geschichte, Entwicklung und Befunde. In M. Hermer & B. Röhrle (Eds.), Handbuch der therapeutischen Beziehung (Vol. 1, pp. 15–108). Tübingen: DGVT.
Hill, C. L., & Lambert, M. J. (2004). Methodological issues in studying psychotherapy processes and outcomes. In M. J. Lambert (Ed.), Bergin and Garfield′s handbook of psychotherapy and behavior change (5th ed., pp. 84–136). New York: Wiley.
Hoffmann, S. O. (2002). Unerwünschte und schädliche Wirkungen von Psychotherapie. In D. Mattke, Hertel, G., Büsing, S., Schreiber-Willnow, K. (Ed.), Störungsspezifische Konzepte und Behandlung in der Psychosomatik (vol. 15–32.). Frankfurt a.M: VAS.
Hoffmann, S. O., Rudolf, G., & Strauß, B. (2008). Unerwünschte und schädliche Wirkungen von Psychotherapie. Eine Übersicht mit dem Entwurf eines eigenen Modells. Psychotherapeut, 53, 4–16.
Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139–149.
Jacobi, F. (2002). Risiken und Nebenwirkungen verhaltenstherapeutischer Behandlung. In M. Märtens & H. G. Petzold (Eds.), Therapieschäden. Risiken und Nebenwirkungen von Psychotherapie (pp. 89–109). Mainz: Matthias-Grünewald-Verlag.
Kim, D. M., Wampold, B. E., & Bolt, D. M. (2006). Therapist effects in psychotherapy: A random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data. Psychotherapy Research, 16(2), 161–171.
Kindlon, T. (2011). Harms of cognitive behavior therapy designed to increase activity levels in chronic fatigue syndrome: Questions remain. Psychotherapy and Psychosomatics, 80, 110–111.
Kraus, D. R., Castonguay, L., Boswell, J. F., Nordberg, S. S., & Hayes, J. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapie Research, 21(3), 267–276.
Lambert, M. J. (2004). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (5th ed.). New York: Wiley.
Lambert, M. J. (2010). Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice. Washington, DC: American Psychological Association.
Lambert, M. J., & Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy. In J. C. Norcross (Ed.), Psychotherapy and relationships at work (pp. 17–32). New York: Oxford University Press.
Levitt, H. M., Butler, M., & Hill, C. (2006). What clients find helpful in psychotherapy: Developing principles for facilitating moment-to moment change. Journal of Counseling Psychology, 53(4), 314–324.
Mayring, P. (2000). Qualitative Inhaltsanalyse: Grundlagen und Techniken. Weinheim: Deutscher Studien Verlag.
Nadelson, C. C., Notman, M. T., & McCarthy, M. K. (2005). Gender issues in psychotherapy. In Oxford textbook of psychotherapy (pp. 411–420). Oxford: Oxford University Press.
Neises, M., & Barolin, G. S. (2009). Gender-spezifische Aspekte in der Psychotherapie. Wiener Medizinische Wochenschrift, 159(11–12), 281–287. doi:10.1007/s10354-009-0680-x.
Nolan, S. A., Strassle, C. G., Roback, H. B., & Binder, J. L. (2004). Negative treatment effects in dyadic psychotherapy: A focus on prevention and intervention strategies. Journal of Contemporary Psychotherapy, 34(4), 311–330.
Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield′s handbook of psychotherapy and behavior change (5th ed., pp. 307–389). New York: Wiley.
Rennie, D. L. (2000). Aspects of client’s conscious control of the therapeutic process. Journal of Psychotherapy Integration, 10(2), 151–167.
Sonnenmoser, M. (2002). Geschlechtsspezifische Unterschiede: Vernachlässigte Gender-Perspektive. Deutsches Ärzteblatt PP, 7, 317.
Stiles, W. B., Barkham, M. B., Connell, J., & Mellor-Clark, J. (2008). Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: Replication in a larger sample. Journal of Consulting and Clinical Psychology, 76, 298–305.
Strauss, A. L. (1987). Qualitative analysis for social scientists. Cambridge: Cambridge University Press.
Strauß, B., & Wittmann, W. W. (2005). Psychotherapieforschung: Grundlagen und Ergebnisse. In W. Senf, & M. Broda (Eds.), Praxis der Psychotherapie. Ein integratives Lehrbuch (pp. 760–781). Stuttgart: Thieme.
Strupp, H. H., Fox, R. E., & Lessler, K. (1969). Patients view their psychotherapy. Baltimore: John Hopkins Press.
Strupp, H. H., Hadley, S. W., & Gomes-Schwartz, B. (1977). Psychotherapy for better or worse: An analysis of the problem of negative effects. Montvale: Jason Aronson.
Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73(5), 914–923.
Welker, M., Werner, A., & Scholz, J. (2005). Online-Research. Markt- und Sozialforschung mit dem Internet. Heidelberg: dpunkt.verlag GmbH.
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Leitner, A., Märtens, M., Koschier, A. et al. Patients’ Perceptions of Risky Developments During Psychotherapy. J Contemp Psychother 43, 95–105 (2013). https://doi.org/10.1007/s10879-012-9215-7
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DOI: https://doi.org/10.1007/s10879-012-9215-7